Lecture 03 - Substantive Epidemiology of a Disease Example:...

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Substantive Epidemiology of Substantive Epidemiology of a Disease a Disease Example: Multiple Sclerosis January 28, 2010
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What is included in the Substantive What is included in the Substantive Epidemiology of a Disease? Epidemiology of a Disease? 1) Biology of Disease: Types of MS How is it diagnosed? 1) Distribution of Disease: Incidence and Prevalence Person, Place, Time Mortality 1) Risk Factors for Disease: Genetic Environmental: Noninfectious factors Infectious factors 1) Assessment of Causality: Hill’s Criteria For major risk factors
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Background and Biology Background and Biology What is MS? Disease where the autoimmune system attacks the neurons Leads to demyelination What is the (understood) mechanism of action? Demyelination results in less effective signal conduction
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Background and Biology (2) Background and Biology (2) Emerging MS Hypothesis: Recent research brought attention to chronic cerebrospinal venous insufficiency (CCSVI) hypothesis Idea that impairment in venous drainage from brain may lead to inflammation Thought that inflammation causes demyelination instead of autoimmune activity
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Figure 1: A Neuron affected by MS Figure 1: A Neuron affected by MS contrasted with a healthy neuron contrasted with a healthy neuron
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Symptoms of MS Symptoms of MS Neurologic symptoms lead to physical and cognitive symptoms Symptoms include: changes in sensation muscle weakness muscle spasms Then progress Can occur discretely or slowly accumulate Several forms of MS, each with its own etiology
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Forms of MS Forms of MS Clinically isolated MS Relapsing-Remitting MS (RRMS) Benign MS
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Forms of MS Forms of MS Progressive MS Primary-progressive MS – DIFFERENT TO OTHER FORMS Secondary-progressive
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What is included in the Substantive What is included in the Substantive Epidemiology of a Disease? Epidemiology of a Disease? 1) Biology of Disease: Types of MS How is it diagnosed? 1) Distribution of Disease: Incidence and Prevalence Person, Place, Time Mortality 1) Risk Factors for Disease: Genetic Environmental: Noninfectious factors Infectious factors 1) Assessment of Causality: Hill’s Criteria For major risk factors
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Incidence of MS Incidence of MS MISSING! Difficult to measure incidence 35.7% of MS patients have another condition (Marrie, 2008) Delay in diagnosis due to comorbid conditions (Marrie, 2009) Disease is identified retrospectively Problems with assessing when symptoms first started Incidence is therefore inferred
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International Prevalence - International Prevalence - Place Place Source: Marrie RA. Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol 2004; 3:709-718.
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Canadian Prevalence - Place Canadian Prevalence - Place In Canada: 55,000 – 75,000 cases of MS (MS Society of Canada) Prevalence estimated at 240 per 100,000
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Lecture 03 - Substantive Epidemiology of a Disease Example:...

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